Medicare therapy management and other drug programs

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If you think you take too many medications on a daily basis, you might be right. Taking a long list of pills can be nerve-wracking, especially if they address a variety of interrelated health issues.

Discover whether Medication Therapy Management (MTM) offers a solution for managing your complex health issues, and find out if you’re eligible for a Medication Therapy Management Program (MTMP) under your Medicare coverage.

What is Medication Therapy Management?

MTM refers to a group of services designed to optimize outcomes for patients. The primary components include active prescription management and proactive identification of medication issues.

As the American Pharmacists Association explains, MTM exists because medication management is an expensive and growing issue in the U.S. In fact, prescription-related issues cause an estimated 1.5 million needless negative events every year, resulting in over $175 billion in costs related to injuries and death.

According to the Centers for Medicare & Medicaid Services (CMS), every Medicare Part D sponsor must provide an MTMP for patients. CMS must review program descriptions each year to ensure that each adheres to guidelines and offers benefits including:

  • Improves medication use and safeguards ideal therapeutic outcomes for patients
  • Lowers the chance of the patient experiencing adverse effects
  • Created with the consultation of licensed physicians and pharmacists

How Does a Medication Therapy Management Program Work?

MTMPs are designed to help you, provide you with information, and address your concerns. When you participate in this type of program, you’ll start by getting a Comprehensive Medication Review (CMR) from a health care professional. During this process, you’ll talk with a physician or pharmacist to produce a list of every prescription drug, over-the-counter medication, herbal remedy, and dietary supplement you take.

Shortly after your CMR, you’ll receive a group of documents from the same health care professional. These documents may arrive by mail or email or you may access them by logging into a secure website. No matter how you receive the documents, they’ll include a cover letter, a Medication Action Plan, and a Personal Medication List.

These standardized documents provide a summary of your conditions and suggestions for how to manage your medications. Health care professionals generally recommend that you notate these documents as necessary and ask your physicians and pharmacists to update them when medications or conditions change.

The Medication Action Plan highlights specific conditions you discussed during the CMR, such as diabetes, high cholesterol, or high blood pressure. The plan details steps you should take to improve these conditions, such as monitoring your diet or making a follow-up appointment with your doctor. The Medication Action Plan also includes a blank section for you to fill in what you did to meet these recommendations.

The Personal Medication List details every medication and supplement you take, including the dosage, the method for taking it, the reason for taking it, and the prescribing doctor. This document also lists the date you began taking the medication, along with its overall goals for your condition.

Where Can You Get Medication therapy Management?

Depending on your Medicare plan and the programs available in your area, you may have a few options for pursuing MTM. Some physicians and health care professionals provide this service in their offices, while others offer virtual MTM through telehealth technology. Many pharmacists also provide MTM services in their pharmacies. To find out where you can benefit from these services, call your Part D sponsor for details.

Who Qualifies for Medication Therapy Management?

While it isn’t necessary for everyone, MTM can be very beneficial to a number of patients. You may be a good candidate for this program if you meet one of the following criteria:

  • You have a combination of health issues or chronic diseases.
  • You take several prescription and non-prescription medications.
  • You’ve had trouble managing the various medications you take.
  • Your medications require a health care professional to monitor them closely.
  • You get your medications from multiple pharmacies.

As Medicare.gov explains, you must have a Medicare drug plan, or Medicare Part D, to qualify for an MTMP. Keep in mind that these plans vary widely, depending on which insurance provider or private company sponsors them. That means different prescription drug plans may have unique requirements to determine your eligibility. For instance, you may need to have a minimum of three chronic diseases to qualify.

To find out if your plan covers your participation in an MTMP, simply call your Part D or prescription drug coverage sponsor. Be sure to ask about the specifics of the program, such as where to go for services and how often you should receive a CMR.

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